Survey of ophthalmology最新文献

A 38-year-old man with poorly controlled type 2 diabetes mellitus and arterial hypertension on semaglutide presented with acute, painless, vision loss in the left eye. Ophthalmic examination revealed optic disc edema (ODE) in the left eye and optic disc pallor (ODP) in the right eye, accompanied by severe nonproliferative diabetic retinopathy and cystoid macular edema in both eyes. The combination of ODE in one eye and ODP in the fellow eye raised concern for the Foster Kennedy syndrome secondary to an intracranial mass; however, neuroimaging and systemic evaluation were unremarkable. Ultimately, it was decided the ODP was due to a prior unrecognized non-arteritic anterior ischemic optic neuropathy (NAION) event, and the ODE was the result of an acute NAION in the symptomatic fellow eye (i.e. pseudo-Foster Kennedy syndrome).

Rhegmatogenous retinal detachment (RRD) is a major cause of vision loss requiring prompt surgical intervention. Recent advances in multimodal retinal imaging, especially macular and peripheral optical coherence tomography (OCT), have significantly improved our understanding of the various factors and biomarkers influencing the clinical outcomes after RRD repair. Several visual disturbances, such as metamorphopsia and aniseikonia, typically persist despite successful reattachment, significantly impacting patients' quality of life. Factors influencing recovery include the timing of surgery, the extent of retinal displacement, and structural integrity of retinal layers. Additionally, recent research is increasingly highlighting the relevant role of numerous OCT biomarkers, including hyperreflective dots, ellipsoid zone, external limiting membrane and outer retinal disruption, and bacillary layer detachment in prognosis. We provide an overview on the above-mentioned factors implied in RRD-related postsurgical prognosis in order to optimize clinical practice.

The corneal triple procedure, combining keratoplasty, cataract extraction, and intraocular lens implantation, remains a valuable option for patients with concurrent corneal opacity and cataract. We synthesize historical and contemporary evidence on penetrating keratoplasty (PKP), anterior lamellar keratoplasty (ALK), and endothelial keratoplasty (EK) triple procedures, highlighting their indications, surgical techniques, outcomes, and evolving trends. PKP triple is indicated for full-thickness scarring, keratoconus with central scarring, and cases with anterior segment abnormalities, but remains technically demanding due to open-sky cataract surgery and postoperative refractive unpredictability. ALK triple offers tectonic and visual rehabilitation in stromal disorders sparing the endothelium, though technically challenging. EK triple procedures, particularly Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty, are increasingly preferred in endothelial disorders such as Fuchs endothelial corneal dystrophy, offering faster recovery, more predictable refraction, and better graft survival. Advances in capsulotomy, nucleus management, intraocular lens power calculation, and perioperative strategies have improved safety and refractive outcomes across triple procedures. Long-term studies reveal that although visual and anatomical success rates remain high, complications such as graft rejection, glaucoma, and posterior capsular opacification persist. Careful patient selection and tailored surgical planning are essential, as triple procedures continue to evolve toward safer and more predictable outcomes.

Intra-arterial chemotherapy (IAC) has emerged as a targeted alternative to conventional systemic chemotherapy (CC) for retinoblastoma, but their comparative effectiveness and safety remain incompletely defined. This systematic review and meta-analysis evaluated whether IAC is superior to CC for survival, globe preservation, and metastasis prevention in pediatric intraocular retinoblastoma. We searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar from inception to June 1, 2025, for English-language human studies directly comparing IAC with CC and reporting at least one primary outcome. Eligible designs included randomized trials and comparative cohort or observational studies. Risk of bias was assessed using Cochrane tools, and random-effects models generated pooled risk ratios with 95% confidence intervals. Twelve comparative studies including 6,261 children and more than 5,000 treated eyes met the criteria. Compared with CC, IAC was associated with higher overall survival (risk ratio 1.12, p < 0.00001) and event-free survival (risk ratio 1.43, p < 0.0001), higher globe salvage (risk ratio 1.33, p < 0.00001), and a lower risk of enucleation (risk ratio 1.69, p < 0.00001), particularly in advanced International Classification of Retinoblastoma Group D and E eyes. IAC also reduced metastatic events by 54% (risk ratio 0.46, p = 0.03). Heterogeneity was low across primary outcomes, and no meaningful publication bias was detected. These findings indicate that IAC provides superior survival, ocular preservation, and metastatic protection compared with CC, supporting its use as a preferred frontline or adjunctive therapy for intraocular retinoblastoma where technical expertise and resources permit.

In this scoping review, we examine the implications of 3 pillars (housing conditions and quality, residential consistency, and housing affordability) of healthy housing on vision health outcomes. We examine barriers based on geographical locations of the studies and World Health Organization income levels. We identified 11,190 abstracts, with 10,996 articles retrieved. Sixty-three met inclusion criteria. Among these, housing conditions emerged as the most frequently observed housing pillar associated with adverse vision health outcomes, cited in 62.1 % of the studies. Environmental pollution, particularly indoor air quality and exposure to harmful substances, was the most common condition associated with poor vision outcomes.

Initially designed for the treatment of type-2 diabetes, glucagon-like peptide-1 receptor agonists (GLP-1RA) are multifaceted agents with promising neuroprotective and anti-inflammatory properties. The majority of the research exploring the relationship between GLP-1RA use and ophthalmic disease comes from large database studies or secondary-analysis of randomized controlled trials investigating GLP-1RAs in cardiovascular disease and obesity. Current evidence regarding the impact of GLP-1 receptor agonists on ophthalmic diseases remains inconsistent, with studies reporting both protective and detrimental effects. For example, there are conflicting findings of an effect on diabetic retinopathy and non-arteritic anterior ischemic optic neuropathy, as well as age-related macular degeneration, with GLP-1RA use. In contrast, GLP-1RAs have more consistently demonstrated a protective effect against idiopathic intracranial hypertension, glaucoma and dry-eye disease. Importantly, the majority of the clinical ophthalmic studies are from large electronic health record databases. Overall, limitations in the design of these studies, such as the lack of manual chart review and potential miscoding of diagnosis or treatments, prohibit a more granular analysis of comprehensive ocular endpoints. As a heterogenous medication class with differing structures, potencies, and mechanisms of action, we outline the ophthalmic effects of all Food and Drug Administration-approved GLP-1RAs. We discuss the proposed mechanisms of ocular effects and GLP-1RA use, examine the current literature investigating the impact of GLP-1RAs on ophthalmic disease, discuss the effects of specific GLP-1RAs, and outline the perioperative considerations of this medication class.

We conducted a systematic review on the clinical and imaging characteristics of age-related choroidal atrophy (ARCA) that distinguish ARCA from age-related macular degeneration (AMD) and geographic atrophy (GA). Studies were included if they reported on ARCA using clinical or multimodal imaging criteria and differentiated it from AMD and GA. Extracted data included subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), inner retinal layer thicknesses, and fundus findings. Risk of bias was assessed using the Joanna Briggs Institute checklists. Narrative synthesis and descriptive statistics were performed (PROSPERO (ID: CRD420251041101)). Seven studies (n = 329 patients) met inclusion criteria. ARCA was characterized by choroidal thinning (mean SFCT: 69.8-96.45 µm), preserved retinal pigment epithelium (RPE) on fundus autofluorescence, scleral visibility, and fundus features including peripapillary atrophy (83.3 %), tessellated fundus, and pseudodrusen. Compared to control, patients with ARCA had significantly thinner peripapillary nerve fiber layer (mean: 84.2 µm vs. 90.2 µm; p = 0.047) and reduced mean ganglion cell layer, macular internal plexiform layer and CVI. ARCA contrasts with AMD and GA by its distinct imaging features, less severe visual impairment, higher glaucoma prevalence (35.3 %), and more favorable response to anti-vascular endothelial growth factor agents when choroidal neovascularization is present. ARCA is a distinct clinical entity characterized by specific choroidal and retinal findings on multimodal imaging including lower CVI, thin SFCT, preserved RPE with scleral visibility, peripapillary atrophy, and inner retinal thinning. Further studies are warranted to standardize diagnostic criteria and understand long-term outcomes of ARCA.

The anatomy and physiology of aqueous humour (AH) are essential to maintaining ocular health and managing diseases such as glaucoma, diabetic retinopathy, and Fuchs endothelial corneal dystrophy (FECD). This review compiles recent findings on AH dynamics, molecular composition, and clinical applications. AH, produced by the ciliary processes, supports intraocular pressure regulation, nourishes avascular tissues, and preserves immune privilege within the eye. Production occurs through diffusion, ultrafiltration, and active secretion, while drainage relies on trabecular and uveoscleral pathways. Imbalances in these processes can lead to ocular diseases. Elevated levels of cytokines, oxidative stress markers, and growth factors in AH have been associated with conditions such as glaucoma, diabetic retinopathy, and postoperative inflammation. Advanced technologies, including proteomics, metabolomics, and aqueous angiography, have revealed the diagnostic and therapeutic potential of AH analysis. Specific cytokine and metabolic profile changes in diabetic patients correlate with disease severity, while cytokine alterations can influence surgical outcomes in FECD and cataract surgery. Understanding the composition and behaviour of AH is critical for developing precise diagnostic tools and treatments for ocular diseases. Additionally, insights into AH's role in surgical recovery emphasize the importance of customized perioperative care, particularly for patients with conditions such as FECD or diabetes.

Age-related macular degeneration (AMD) is a progressive and irreversible degenerative disease of the retina. Slowing progression to late AMD is the only way to prevent vision loss. Given that AMD treatments are noncurative, understanding the personal characteristics associated with progression is of critical importance for people with increased AMD risk. We conducted an overview of systematic reviews and meta-analyses (SRMAs) to assess the scope of the existing literature on prognostic factors (PFs) for AMD progression. We included all systematic reviews of PFs for the progression of AMD from early or intermediate to late. We used the Cochrane Eyes and Vision Database of Systematic Reviews (current to September, 2024). We identified 64 potentially relevant studies in the database and included 17 SRMAs, which most commonly studied functional or structural ocular (10/17), lifestyle (7/17), and intervention-related factors (7/17). Across all reviews, 218 PFs were reported. We extracted 79 and grouped these into 20 distinct types of PFs across 8 categories. The modifiable PFs with most evidence for slowing progression were increased dietary supplementation with antioxidants and multivitamins and reduced smoking. Most PFs were non modifiable. Although most PFs may not be targetable, by integrating high-risk optical coherence tomography findings, monitoring relevant comorbidities, and considering individual lesion characteristics, clinicians may better predict disease trajectories and support patients in slowing progression and preserving vision. Notably, no reviews studied social determinants as potential PFs for AMD progression, representing a critical gap in the evidence base. Future reviews should investigate social, systemic, and AI-identified biomarkers to provide a more comprehensive understanding of AMD progression.

Deep-learning (DL) algorithms are widely promoted for diabetic-retinopathy (DR) screening, yet their prospective diagnostic accuracy is not well defined. PubMed, EMBASE and ClinicalTrials.gov were searched to April 2025 for prospective evaluations of DL systems using color-fundus images. Two reviewers screened records, extracted data, and applied QUADAS-2. Hierarchical bivariate random-effects models produced pooled sensitivity and specificity for referable and vision-threatening DR), analyzed separately at patient and eye level. Twenty-one prespecified moderators were explored with uni- and multivariate meta-regression; publication bias was assessed with Deeks' test Seventy-three studies from 23 countries (255,330 examinations) met the criteria. Pooled patient-level sensitivity was 0.94 (95 % CI 0.92-0.95) and specificity 0.90 (95 % CI 0.87-0.93); eye-level values were 0.93 (95 % CI 0.91-0.95) and 0.94 (95 % CI 0.92-0.96). DR subtype, retinal-field strategy, camera form factor, and prevalence independently explained heterogeneity (p < 0.05). Performance matched or exceeded pivotal FDA trials (IDx-DR, EyeArt). AI gradability was ≥95 % in 60 % of cohorts, including handheld and smartphone systems. DL-based DR screening achieves consistent, high accuracy across devices and care settings, enabling scalable deployment in primary care, pharmacies, and mobile clinics. Quality assurance and ongoing monitoring are essential to maximize population-level benefits.